Journal of cataract and refractive surgery最新文献

Purpose: To investigate the safety and refractive outcomes of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) capsulotomy in pseudophakic eyes with the Light Adjustable Lens (LAL) both before and after completing the light delivery device (LDD) lock-in treatments.

Setting: Private practice in Orange, California, USA.

Design: Retrospective, comparative study.

Methods: Patients were divided into two groups according to the timing of their YAG capsulotomy (Group I underwent YAG capsulotomy before lock-in treatments and Group II underwent YAG capsulotomy upon completion of lock-in treatments). Sphere, cylinder, axis, spherical equivalent, uncorrected visual acuity, and best-corrected visual acuity were compared pre- and postoperatively using two-tailed paired t-tests. Postoperative data were measured one month after Nd:YAG capsulotomy. The alpha level (type I error) was set at 0.05.

Results: The LAL was successfully implanted in 485 eyes from January 2020 to March 2023. Ten eyes (0.02%) needed YAG capsulotomy prior to the completion of lock-in treatments (Group I) and 28 eyes (5.77%) needed YAG capsulotomy after the lock-in was completed (Group II). Postoperative BCVA significantly improved compared to preoperative values in both groups. Changes in sphere, cylinder, axis, SE, and UCVA pre- and postoperative measurements were not statistically significant (p > 0.05) in both groups.

Conclusions: YAG capsulotomy can be safe and effective for patients with the LAL who develop PCO during the adjustment period. There were no significant changes in sphere, cylinder, axis, or spherical equivalence after YAG capsulotomy in both groups.

Purpose: This study aimed to evaluate leaflets on cataract surgery produced by seven common free chatbots.

Setting: Usage of conversational artificial intelligence services (chatbots) is becoming more prevalent in all aspects of life, including healthcare. Cataract surgery is the most commonly performed operation in the world, with numbers set to increase. Possible applications for chatbots include information giving and education, allowing clinicians to allocate their time more efficiently.

Design: Analysis of answers given by seven chatbots (Bing AI, chatGPT 3.5, chatGPT 4o, ChatSonic, Google Bard, Perplexity and Pi) were prompted to "make a patient information leaflet on cataract surgery".

Methods: Answers were evaluated using the DISCERN instrument, Patient Education Materials Assessment Tool (PEMAT), presence of misinformation, the Flesch-Kincaid Grade Level readability score and material reliability.

Results: The highest overall scored response was from ChatSonic, followed by Bing AI and then Perplexity. The lowest scoring was ChatGPT 3.5.ChatSonic achieved the highest DISCERN and PEMAT scores, and had the highest Flesch-Kincaid Grade level. The lowest DISCERN and PEMAT scores were for Pi. Only ChatGPT 3.5 included some misinformation in its response. Bing AI, ChatSonic and Perplexity included reliable references; the other chatbots provided no references.

Conclusions: This study demonstrates a range of answers given by chatbots creating a cataract surgery leaflet, suggesting variation in their development and reliability. ChatGPT 3.5 scored the most poorly. However, ChatSonic indicated promise in how technology may be used to assist information giving in ophthalmology.

Purpose: We analyzed intraocular lens (IOL) power calculation in a series of patients with a zero diopter power implant. The idea was to bypass the Estimated Lens Plane (ELP), an important variable in normal IOL calculation.

Setting: Large multi-center group practice.

Design: Retrospective, observational study.

Methods: A consecutive series of patients undergoing cataract surgery after optical biometry and implantation of a zero (0.0 D) power IOL were studied. Complete biometry was performed with an optical low coherence optical biometer. The predicted refraction was calculated with and without recalibrating the axial length (AL) using a Sum-Of-Segments (SOS) approach with the Hoffer Q, Holladay 1, SRK/T, Haigis, Barrett Universal II, and Olsen formulas. A ray tracing model to back-calculate the corneal power from the observed postoperative refraction and AL was also included.

Results: In 52 eyes of 52 patients, mean prediction errors for the Hoffer Q, Holladay 1, SRK/T, Haigis, Barrett Universal II, and the Olsen formulas were +1.48, +1.15, +0.91, +0.65, +0.15 and +0.11 D respectively using standard AL and after SOS correction of the AL the mean errors changed to +1.08, +0.75, +0.52, +0.26, -0.25, and -0.27 D respectively. The mean back-calculated corneal power was 1.25 D lower than the mean keratometer reading using the standard keratometric index of 1.3375 and corresponded to an effective index of 1.328.

Conclusions: The hyperopic error commonly seen in highly myopic eyes with classical thin-lens formulas is only partly corrected by SOS recalibration of the AL. We suggest the source of the residual error is an incorrect keratometric index.

Purpose: To evaluate the symptoms, etiology and treatment of patient dissatisfaction after extended depth-of-focus (EDOF) intraocular lens (IOL) implantation.

Setting: University Eye Clinic, Maastricht University Medical Center, the Netherlands.

Design: Retrospective case series.

Methods: For this study, all medical records of patients who received an EDOF IOL from July 2020 to July 2022 were reviewed. Patients were included if they had reported any dissatisfaction after surgery. The main outcome parameters were reasons for dissatisfaction (subjective complaints) and the presumed etiology of the complaints.

Results: Out of 202 patients (354 eyes) who underwent EDOF IOL implantation, 83 eyes (22.8%) of 52 dissatisfied patients were included. Blurred vision was the predominant complaint, reported in 78 eyes (94%). Photic phenomena were reported in 21 eyes (25.3%), with 16 eyes (76.2%) experiencing coexisting blurred vision. The major etiologies for dissatisfaction in this cohort were residual ametropia (51.8%), dry eye disease (26.5%), and posterior capsular opacification (12.0%). Treatments were administered to 85.5% of the eyes, including interventions such as artificial tears, spectacles, or refractive surgery enhancement. A small number of patients (n=12; 5.9%) remained dissatisfied despite intervention.

Conclusion: Based on this real-world data study, dissatisfaction following EDOF IOL implantation can be effectively identified and treated in most cases.

Purpose: To compare the refractive accuracy of the Barrett True axial length (BTAL) formula, newly integrated into ARGOS, with that of the Barrett Universal II (BUII) formula calculated using axial length (AL) from IOL Master 700.

Setting: Private clinics in Kanagawa, Japan.

Design: Retrospective observational study.

Methods: We assessed eyes of patients who underwent cataract surgery with SY60WF IOL implantation, using ARGOS and IOL Master 700. The predicted refraction for BTAL was back-calculated. Refractive prediction errors (RPEs) for BTAL, BUII with ARGOS (segmented BUII), and BUII with IOL Master 700 (composite BUII) were compared. We primarily aimed to demonstrate the non-inferiority of BTAL to composite BUII in absolute RPE.

Results: We included 209 eyes from 209 patients. BTAL met the non-inferiority criteria, as the upper confidence interval (CI) boundary was below the non-inferiority margin of 0.10 diopters (D) for the difference in absolute RPE (-0.03 D; 95% CI: -0.06 to 0.01). In short eyes (AL ≤ 22.5 mm), the median absolute RPEs for BTAL, segmented BUII, and composite BUII were 0.25, 0.18, and 0.37 D, respectively, with significant differences between BTAL and composite BUII (p = 0.028) and segmented BUII and composite BUII (p = 0.018). In long eyes (AL > 26 mm), the median absolute RPEs were 0.21, 0.20, and 0.28 D for BTAL, segmented BUII, and composite BUII, respectively.

Conclusions: BTAL was non-inferior to composite BUII in absolute RPE. BTAL is an accurate and useful intraocular lens power calculation formula, even in eyes with short and long AL.

Purpose: To compare the efficiency of peristaltic vs venturi vacuum platforms when applied to the femtosecond treated cataract.

Setting: Outpatient Eye Center, Mercy Health System, Springfield, MO, USA.

Design: This is a prospective randomized controlled trial of 111 patients with moderate nuclear sclerosis scheduled for bilateral routine laser cataract surgery (clinicaltrials.gov; NCT03970525).

Methods: Patients were randomized to receive surgery in one eye with a peristaltic system and the other with a venturi system. The vacuum and phaco power were the same for both systems. The primary outcomes were EFX, UST (ultrasound time), PIOT (phaco in/out time), surgery time (speculum in/out time), and the ECC (endothelial cell count).

Results: The type of vacuum/phacoemulsification system used during laser cataract surgery had a significant impact on the four procedural outcomes. Specifically, phacoemulsification energy (EFX), ultrasound time (UST), phaco tip in/out time (PIOT), and total microscope time (speculum in/out case time) were lower when the venturi system was used compared to the peristaltic system (t(100)=-4.28, p <.001). The vacuum system used did not impact the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) or central cornea thickness (CCT). ECC decreased 6.38% with venturi and 8.32% with peristaltic (t(87) = 1.19, p = .235). There were no complications.

Conclusion: Venturi-based phaco was more efficient than peristaltic, based on energy and time, when used for removal of the femtosecond treated cataract.

Purpose: To describe the causes, timing, and contributing factors of direct hospital transfer cases from an ophthalmology-specific ambulatory surgery center and to identify potential strategies for decreasing future transfers.

Setting: A large ophthalmology surgery center in Des Moines, Iowa.

Design: Retrospective review.

Methods: A retrospective chart review was performed on patients requiring hospital transfer from a Midwest ophthalmology-specific surgery center from March 2022 through July 2024. Variables reviewed included patient demographics, comorbidities, prior surgeries/surgical complications, results of pre-operative physical exams, type of surgery and anesthesia performed, the type and timing of each complication, and the reasons for transfer. Each transfer was assessed for its necessity, preventability, and outcome.

Results: A total of 22 patients required hospital transfer out of 24,960 admissions for a rate of 0.88 per 1,000 admissions (95% CI: 0.58-1.33). Only 5 (23%) transfer cases were temporally related to anesthesia or surgery. The other 17 (77%) had concerns first noted prior to the induction of anesthesia. Nine (41%) of the surgeries were completed, 1 (5%) partially completed, and the remaining 12 (55%) surgeries were cancelled. The reasons for transfer were largely cardiac and/or blood pressure related (18/22, 82%). Nearly a third of the transfers (7/22, 32%) were considered preventable.

Conclusion: Hospital transfers from ASCs are rare and all-cause hospital transfer rates may overestimate the true risk of ocular surgery. Most patients requiring hospital transfer were identified in the pre-operative area. Greater attention to preoperative physical exam reports could potentially prevent some hospital transfers.

Purpose: To comprehensively evaluate the tilt of the crystalline lens in phakic eyes and its relationship with optical biometry parameters.

Setting: The retrospective analysis was conducted at the Department for Ophthalmology and Optometry, Kepler University Clinic in Linz, Austria.

Design: Lens tilt assessment was performed through a combined analysis of optical biometry (IOL Master 700) and anterior segment optical coherence tomography (AS-OCT) data to understand its relationship.

Methods: The study analyzed preoperative biometry data and AS-OCT images from 4689 eyes of 2489 patients prior to cataract surgery. The optical biometry parameters were correlated with the degree of lens tilt using logistic regression and machine learning techniques.

Results: The average lens tilt was 4.9°, with 6.7% of eyes showing a tilt greater than 7°. Significant associations were found with specific biometry parameters, such as anterior chamber depth (ACD), axial length (AL), equator thickness and lens decentration. The developed predictive model for assessing tilt risk demonstrated a high accuracy with an area under the curve of 0.862.

Conclusions: The findings highlight the average lens tilt of 4.9° in a cataract patient cohort. This analysis contributes to a broader understanding of lens orientation and its interactions with biometric parameters.

Purpose: To measure visual acuity at three different defocus planes in pseudophakic subjects with varying levels of spherical aberration induced by an adaptive optics visual simulator. The study aimed to simulate Extended Depth of Focus (EDOF) intraocular lenses (IOLs).

Setting: Private hospital (IMO, Barcelona, Spain).

Design: Observational case series; modelling theory.

Methods: Through-focus visual acuity was measured in 26 pseudophakic subjects (age 63 ± 10 years old) with an adaptive optics visual simulator optimized for clinical use (VAO, Voptica SL, Murcia, Spain). Measurements were made under five different conditions of induced negative spherical aberration: 0, -0.07, -0.15, -0.23 and -0.30 μm (pupil diameter: 4.5 mm). Results were also modelled using ray tracing simulations.

Results: On average, depth of focus was extended when spherical aberration increased from -0.07 to -0.15 μm (4.5 mm pupil diameter). Some indivisuals (27%) experienced improved depth of focus with higher magnitudes of spherical aberration, while others (23%) exhibited no benefit from increased (negative) SA, as visual acuity dropped below acceptable levels. Depth of focus calculations based on ray tracing showed general agreement with the measurements.

Conclusions: The visual conditions of EDOF IOLs were artificially recreated in a population of pseudophakic patients implanted with a monofocal IOL. The variability seen across subjects in visual acuity at different defocus planes suggests that visual simulators might be capable of screening subjects for suitability and tolerability of these advanced technology lenses.